<form action="{php echo web_url('halfcard/realcard/editrealcard')}" method="post" class="form-horizontal form-validate">
	<div class="modal-dialog" style="z-index: 50;">
		<div class="modal-content">
			<div class="modal-header">
				<button data-dismiss="modal" class="close" type="button">×</button>
				<h4 class="modal-title">编辑实卡</h4>
			</div>
			<div class="modal-body" style="margin-left: 100px;">
				<div class="form-group">
					<label class="col-sm-2 control-label">实体卡时长</label>
					<div class="col-sm-7 col-xs-12">
						<div class="input-group">
							<input type="text" name="days" class="form-control" value="{$realcard['days']}" />
							<span class="input-group-addon">天</span>
						</div>
					</div>
				</div>
				<div class="form-group">
					<label class="col-sm-2 control-label">会员等级</label>
					<div class="col-md-7">
						<select name="levelid" style="width: 100%;">
							<option value="0" {if $realcard['levelid'] == 0 || empty($realcard['levelid'])} selected="selected" {/if} >{$_W['wlsetting']['halflevel']['name']}</option>
							{loop $levels $level}
							<option value="{$level['id']}" {if $realcard['levelid'] == $level['id']} selected="selected" {/if} >{$level['name']}</option>
							{/loop}
						</select>
					</div>
				</div>
				<div class="form-group">
					<label class="col-sm-2 control-label">修改备注</label>
					<div class="col-sm-7 col-xs-12">
						<div class="input-group" style="width: 100%;">
							<input type="text" name="remark" value="{$realcard['remark']}" class="form-control"/>
						</div>
					</div>
				</div>
				<div class="form-group">
					<label class="col-sm-2 control-label">更新范围</label>
					<div class="col-sm-9">
						<label class="radio-inline">
							<input type="radio" value="0" name="range" checked="checked"> 仅此条
						</label>
						<label class="radio-inline">
							<input type="radio" value="1" name="range" > 同备注
						</label>
					</div>
				</div>
			</div>
			<div class="modal-footer">
				<input type="hidden" name="id" id="id" value="{$realcard['id']}" />
				<button type="button" class="btn btn-default" data-dismiss="modal">关闭</button>
				<button type="submit" class="btn btn-primary">提交更改</button>
			</div>
		</div>
	</div>
</form>
